BEUDAMED
    FDA Adverse Event Other Summary report: N

    SHAMPAINE

    MDR report key: 838262 · Received February 13, 2007

    Report

    Report Number
    3019090-2007-00001
    Event Type
    Other
    Date Received
    February 13, 2007
    Date of Event
    January 31, 2007
    Report Date
    January 31, 2007
    Manufacturer
    GETINGE USA, INC., F.K.A. MDT DIAGNOSTIC CO.
    Product Code
    LWG
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    PA, US
    Reporter Occupation
    OTHER

    Narratives

    Additional Manufacturer Narrative · 1

    THE APPLIANCE INLET AT THE BASE OF THE TABLE WAS BROKEN AND TAPED TOGETHER RATHER THAN FIXED OR REPLACED.

    Description of Event or Problem · 1

    THE NURSE WAS PLACING THE ELECTRICAL PLUG INTO THE APPLIANCE INLET AND RECEIVED A SHOCK.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 SHAMPAINE LWG LWG GETINGE USA, INC., F.K.A. MDT DIAGNOSTIC CO. 5100B *

    Patients

    Seq Age Sex Outcome Treatment
    1 38 YR